Evolution of Technique in Performance of Minimally Invasive Colectomies

Abstract

Conversion to hand-assisted laparoscopic surgery provides benefit in surgical scenarios where dense inflammatory adhesions, diverticular fistulas, and intra-abdominal postdiverticulitis phlegmon are present. In addition, benefit is observed in patients with colorectal cancer where laparoscopic dissection of bulky tumor proves to be difficult and where the technical ability to obtain margins using pure laparoscopy is compromised. Although our practice has changed to favor pure laparoscopy, hand-assisted laparoscopic surgery continues to play an important role in complex colorectal cases that otherwise would require open surgery (see video, Supplemental Digital Content 1, http://links.lww.com/DCR/A146).

Thirteen‐year experience with hand‐assisted laparoscopic surgery in colorectal patients

“…The median age at the time of operation was 64 years (54-73). The median body mass index was 26 (24)(25)(26)(27)(28)(29)(30) and 54% were ASA class 2. Eighteen percent were on some form of anticoagulation and 40% had a prior abdominopelvic operation.…”

“…It has been proposed that HALS be considered an alternative to open conversion in minimally invasive approaches such as SLS or single incision laparoscopy . Jadloweic et al . observed great benefit of conversion to HALS in surgical scenarios where dense inflammatory adhesions, post diverticulitis phlegmon, and diverticular fistulas were present and also where laparoscopic dissection of bulky tumour proved difficult and margins were compromised.…”

“…4,5,7,10,11,23 It has been proposed that HALS be considered an alternative to open conversion in minimally invasive approaches such as SLS or single incision laparoscopy. 3,10,24-26 Jadloweic et al 24 observed great benefit of conversion to HALS in surgical scenarios where dense inflammatory adhesions, post diverticulitis phlegmon, and diverticular fistulas were present and also where laparoscopic dissection of bulky tumour proved difficult and margins were compromised. Further studies are required to determine factors that may lead to conversion in SLS so that a different approach can be utilized from the beginning, and if not possible, then an early conversion takes place.…”

Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives

“…With more and more evidence on the safety of laparoscopic resections and with advancing learning curves in minimally invasive colorectal surgery, many surgeons leave handassisted procedures in favor of full laparoscopic procedures, putting handassisted surgery in the background. In an interesting retrospective study Jadlowiec et al [37] investigated the technical evolution of laparoscopic colorectal resection within their tertiary center. Minimally invasive procedures for IBD showed steady growth with a higher number of pure laparoscopic operations, a decrease in the amount of HALSprocedures and a plateau in open resections.…”

Minimally invasive surgery for inflammatory bowel disease: Current perspectives

“…Hand-assisted laparoscopic surgery does reduce the operating time, has reduced conversion rates and reduces the hazards of prolonged anaesthesia, hence should be in the armamentarium of surgeons [11] . Single port laparoscopic surgery (SPLS) is an attractive modification, although more data is required to prove its superiority over other techniques [12] .…”